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Does Hospital Competition Improve Efficiency? An Analysis of the Recent Market-Based Reforms to the English NHS

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  • Zack Cooper
  • Steve Gibbons
  • Simon Jones
  • Alistair McGuire

Abstract

This paper uses a difference-in-difference estimator to test whether the introduction of patient choice and hospital competition in the English NHS in January 2006 has prompted hospitals to become more efficient. Efficiency was measured using hospitals' average length of stay (LOS) for patients undergoing elective hip replacement. LOS was broken down into its two key components: the time from a patient's admission until their surgery and the time from their surgery until their discharge. Our results illustrate that hospitals exposed to competition after a wave of market-based reforms took steps to shorten the time patients were in the hospital prior to their surgery, which resulted in a decrease in overall LOS. We find that hospitals shortened patients' LOS without compromising patient outcomes or by operating on healthier, wealthier or younger patients. Our results suggest that hospital competition within markets with fixed prices can increase hospital efficiency.

Suggested Citation

  • Zack Cooper & Steve Gibbons & Simon Jones & Alistair McGuire, 2010. "Does Hospital Competition Improve Efficiency? An Analysis of the Recent Market-Based Reforms to the English NHS," CEP Discussion Papers dp0988, Centre for Economic Performance, LSE.
    • Handle: RePEc:cep:cepdps:dp0988
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    References listed on IDEAS

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    2. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
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    Cited by:

    1. Stephen W. Davies & Peter L. Ormosi, 2012. "A Comparative Assessment Of Methodologies Used To Evaluate Competition Policy," Journal of Competition Law and Economics, Oxford University Press, vol. 8(4), pages 769-803.
    2. Simon Jones & Jessica Wardlaw & Susan Crouch & Michelle Carolan, 2011. "Modelling catchment areas for secondary care providers: a case study," Health Care Management Science, Springer, vol. 14(3), pages 253-261, September.
    3. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    4. Michiel Bijlsma & Pierre Koning & Victoria Shestalova & Ali Aouragh, 2010. "The effect of competition on process and outcome quality of hospital care: An empirical analysis for the Netherlands," CPB Discussion Paper 157, CPB Netherlands Bureau for Economic Policy Analysis.
    5. Helmut Herwartz & Christoph Strumann, 2014. "Hospital efficiency under prospective reimbursement schemes: an empirical assessment for the case of Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(2), pages 175-186, March.
    6. MORIKAWA Masayuki, 2010. "Economies of Scale and Hospital Productivity: An empirical analysis of medical area level panel data," Discussion papers 10050, Research Institute of Economy, Trade and Industry (RIETI).
    7. Tafti, Elena Ashtari, 2023. "Technology, Skills, and Performance: The Case of Robots in Surgery," CINCH Working Paper Series (since 2020) 78746, Duisburg-Essen University Library, DuEPublico.
    8. Corry, Dan & Valero, Anna & Van Reenen, John, 2011. "UK economic performance since 1997: growth, productivity and jobs," LSE Research Online Documents on Economics 47521, London School of Economics and Political Science, LSE Library.
    9. Elena Ashtari Tafti, 2022. "Technology, skills, and performance: the case of robots in surgery," IFS Working Papers W22/46, Institute for Fiscal Studies.
    10. Charlotte Davies & Paula Lorgelly, 2013. "Hospital Procurement with Concentrated Sellers: A Case Study of Hip Prostheses," Working Paper series, University of East Anglia, Centre for Competition Policy (CCP) 2013-13, Centre for Competition Policy, University of East Anglia, Norwich, UK..
    11. Hacer Özgen Narcı & Yasar A. Ozcan & İsmet Şahin & Menderes Tarcan & Mustafa Narcı, 2015. "An examination of competition and efficiency for hospital industry in Turkey," Health Care Management Science, Springer, vol. 18(4), pages 407-418, December.

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    More about this item

    Keywords

    Hospital Competition; Market Structure; Prospective Payment; Incentive Structure;
    All these keywords.

    JEL classification:

    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L1 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance
    • R0 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - General

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